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Computer-assisted, Le Fort-based, face–jaw–teeth transplantation: a pilot study on system feasiblity and translational assessment

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Le Fort-based face–jaw–teeth transplantation (FJTT) attempts to marry bone and teeth geometry of size-mismatched face–jaw–teeth segments to restore function and form due to severe mid-facial trauma. Recent development of a computer-assisted planning and execution (CAPE) system for Le Fort-based FJTT in a pre-clinical swine model offers preoperative planning, and intraoperative navigation. This paper addresses the translation of the CAPE system to human anatomy and presents accuracy results.

Methods

Single-jaw, Le Fort-based FJTTs were performed on plastic models, one swine and one human, and on a human cadaver. Preoperative planning defined the goal placement of the donor’s Le Fort-based FJTT segment on the recipient. Patient-specific navigated cutting guides helped achieve planned osteotomies. Intraoperative cutting guide and donor fragment placement were compared with postoperative computed tomography (CT) data and the preoperative plan.

Results

Intraoperative measurement error with respect to postoperative CT was less than 1.25 mm for both mock transplants and 3.59 mm for the human cadaver scenario. Donor fragment placement (as compared to the planned position) was less accurate for the human model test case (2.91 mm) compared with the swine test (2.25 mm) and human cadaver (2.26 mm).

Conclusion

The results indicate the viability of the CAPE system for assisting with Le Fort-based FJTT and demonstrate the potential in human surgery. This system offers a new path forward to achieving improved outcomes in Le Fort-based FJTT and can be modified to assist with a variety of other surgeries involving the head, neck, face, jaws and teeth.

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Acknowledgments

The authors gratefully thank Dr. Kevin Wolfe for his expertise and design of the new reference fixation on the human skull. Funding was provided by the 2011 Basic Science Research grant from American Society of Maxillofacial Surgeons, 2012–2014 Academic Scholar Award from American Association of Plastic Surgeons, the Accelerated Translational Incubator Program Award at Johns Hopkins University’s Institute for Clinical and Translational Research (funded by National Institutes of Health), Independent Research and Development funds from the Johns Hopkins Applied Physics Laboratory, and the Abell Foundation Award/Johns Hopkins Alliance for Science and Technology development. This study was made possible, in part, by the Johns Hopkins Institute for Clinical and Translational Research (ICTR) which is funded in part by the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS or NIH (NCATS Grant # UL1TR000424-06).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard The manuscript does not contain clinical studies or patient data and an approval by an ethics committee was not applicable. All human cadaver specimens were donated and prepared in accordance with the bylaws presented by the Maryland State Anatomy Board.

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Authors and Affiliations

  1. Research and Exploratory Development Department, Johns Hopkins University Applied Physics Laboratory, Laurel, MD, USA

    Ryan J. Murphy & Mehran Armand

  2. Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Chad R. Gordon

  3. Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA

    Ehsan Basafa

  4. 3D Medical Applications Center, Walter Reed Naval Memorial Medical Center, Bethesda, MD, USA

    Peter Liacouras & Gerald T. Grant

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  1. Ryan J. Murphy
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  2. Chad R. Gordon
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  3. Ehsan Basafa
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  4. Peter Liacouras
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  5. Gerald T. Grant
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  6. Mehran Armand
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Correspondence to Mehran Armand.

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The views expressed in this article are those of the authors and do not necessarily reflect the official policy, position, or endorsement of the Department of the Navy, Army, Department of Defense, nor the U.S. Government.

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Murphy, R.J., Gordon, C.R., Basafa, E. et al. Computer-assisted, Le Fort-based, face–jaw–teeth transplantation: a pilot study on system feasiblity and translational assessment. Int J CARS 10, 1117–1126 (2015). https://doi.org/10.1007/s11548-014-1114-9

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  • DOI: https://doi.org/10.1007/s11548-014-1114-9

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